You are here: Home → Services → Credit Application
Navigation
Contact Us

If you can't find what you are looking for please Contact Us.

 
International Light
Personal tools

Basic Credit Application


(Required)
Enter your company name
Billing Information
(Required)
Enter your billing address
(Required)
Enter your City
(Required)
Enter your State
(Required)
Enter your ZIP Code
(Required)
Choose your country
Shipping Information
(Required)
Enter your shipping address
(Required)
Enter your City
(Required)
Enter your State
(Required)
Enter your ZIP Code
(Required)
Choose your country
(Required)
Enter the type of business
(Required)
Enter the date this business was established
(Required)
Enter the Employer ID Number (EIN)
Enter the Dun and Bradstreet Number
(Required)
Select the type of incorporated entity
If Incorporated
(Required)
Enter the state where the business was incorporated
(Required)
Enter the year when the business was incorporated
Enter the number of employees
Enter the total annual sales
(Required)
Enter the business website address
(Required)
Enter the business e-mail address
Key Management Members and Owners
(Required)
Enter the name of the manager or owner
(Required)
Enter the title of the manager or owner
(Required)
Enter the precentage of ownership
Bank Information
(Required)
Enter the name of the business's bank
(Required)
Enter the bank address
(Required)
Enter the City
(Required)
Enter the State
(Required)
Enter the ZIP Code
Choose the country
(Required)
Enter the bank phone number
(Required)
Enter the bank fax number
(Required)
Enter the bank account number
(Required)
Enter the name of the bank contact
Reference Information
(Required)
Enter the reference name, addresses, phone and fax numbers
Estimate your monthly purchases
Enter the credit line required
The above information is provided for the purpose of extending credit to our company on your terms of net 30 days. To the best of our knowledge and belief, the information is accurate and may be relied upon in making your credit decision. We authorize our bank and suppliers to furnish you any information necessary to complete your evaluation of our credit history.
(Required)
I have read and agree to the terms and conditions of sale.
Electronic Signature
(Required)
Enter your full name
(Required)
Enter your title
(Required)
F-014e Rev A